CARE OF PATIENTS WITH

TRACTION
Objectives:
After 5 hrs of varied classroom discussion, the level III students will be able
to:
1. define the following terms:
1.1 countertraction
1.2 fixator
1.3 traction
1.4 trapeze
2. state the purpose of traction
3. enumerate the indications and contraindications of traction
4. cite the types and applications of the ff:
4.1 traction
4.2 fixator
5. explain the scientific principles involved in the care of patients with
traction
6. identify the possible complications of traction application
7. discuss the general care for the patients with traction
7.1 assessment of body parts
7.2 handling new traction
7.3 skin care
7.4 turning
7.5 toileting to bathing

DEFINITION OF TERMS:
1. . Counter traction
- pulling force equal and opposite the traction weights. Usually the patients
body weight and bed position adjustment.
2. Fixator
- metallic plate or screw placed on the bone to provide support. It fixes the
origin of prime movers so that the muscle acts in an exerted at the insertion
3. Traction
- is the application of a pulling force, used to stretch soft tissue and to
separate join surfaces on bone fragments . It involves applying as a force of
sufficient magnitude and duration while simultaneous resisting movement of
the body
4. Trapeze
- an overhead patient helping device to promote mobility in bed. A triangular
device hung from the ceiling or from a bar over the bed which can be
adjusted to the patients reach. Patient should be assisted upon changing
positions or sitting.

PURPOSE:

used primarily as a short term intervention until other modalities such

as external or internal fixator are possible reducing the risk of disuse
syndrome
to relieve pain

reduce, align and immobilize fractures, to reduce deformities and to

increase space between opposing surfaces

to maintain proper alignment until bone develops

INDICATIONS:

to reduce fractures the application of traction overcomes the injured

limbs tendency to shorten ( due to muscle spasm) and holds the limb

constantly in a position of corrective extension with the ends of the

fractured bone aligned
immobilization of an area before surgery

control and relieve of painful muscle spasm

stretching adhesions

treatment of painful arthritis, sore muscles and ligaments, dislocations,

degenerated or ruptured intervertebral disks and spinal cord
compression

degenerative joint disease

nerve root syndromes and herniated discs

relief from general, vague back pain

CONTRAINDICATIONS:

Patients with structural diseases secondary to tumor or infection,

rheumatoid arthritis and severe vascular compromise.
Acute strains, sprains and inflammation conditions

Malignancy

aneurysm

APPLICATION OF TRACTION:
1. SKIN TRACTION
- in skin traction, the pull is applied to the client's skin which transmitted the
pull to the musculoskeletal structures. A belt, head halter, foam rubber
wrapped with an elastic bandage, or a foam boot is applied to the client's
skin before the appendage is attached to traction.

TYPES OF SKIN TRACTION

a. Pelvic Traction

used in pelvic fractures to support separated bones. This traction may

be applied by either a belt or a sling. The pelvic belt causes downward
pull on the pelvis, while the pelvic sling supports the pelvis off the bed.
With a pelvic belt,the upper rim of the belt should rest at the top of the
iliac crest and not around the abdomen. This type of traction is a
running traction that is used to reduced muscle spasm of the lower
back, relieve sciatica, immobilize a fractured pelvis, or correct lateral
deviations of the spine.
It is usually applied intermittently, on 2 hours, off 2 hours, while the
client is awake. Weights on the traction are increased gradually. Never
remove or changed the weights on any traction device without a
physician's order.

Care for patients with pelvic traction:

Ensure that the pelvic girdle is properly size for patient
Ensure that pelvic girdle fits snugly over iliac crests and pelvis
Inspect skin areas over iliac crests for pressure points q4h
Provide perineal area hygiene after bedpan use
Ensure integrity by providing back care q4h
Maintain sling placement beneath lower back with buttocks elevated from
mattress. Replace soiled sling.
Lift and turn patients use of trapeze if it alters compressive forces on pelvis
Maintain bed in flat position
Change bed linen from head to foot rather than from side to side

b. Buck's Traction (Buck's Extension)

is a running skin traction that can be used temporarily to immobilize a

fracture of the hip/femur until it is possible to do surgery. It can also be
used to relieve muscle spasms in the lower back, to prevent
contracture after computation, or to realign the vertebrae in a client
with scoliosis.
the leg is wrapped with an elastic roller bandage or tape. Traction is
applied through a weight attached to a spreader bar below the foot. A
foam boot may also be used. The traction pull is toward the pulley at
the bottom of the bed.

Care of patients with Bucks Traction:

Ensure skin integrity by avoiding pressure on heel, dorsum or foot, fibular
head, or malleolus
Maintain counteraction by elevating foot of bed or keeping head of bed flat
Encourage independence with use of trapeze

c. Russell's Traction (Balanced Traction)

downward pull, as in Buck's traction, may be applied to the leg, but an

additional overhead pulley system is incorporated into the traction
apparatus with the leg supported by a sling. The pull is up (toward the
ceiling) and toward the foot of the bed.

Care of patients with Russells Traction:

Assure skin integrity by avoiding pressure on heel, dorsum of foot, fibular
head, or malleolus
Maintain counteraction by elevating foot of bed or keeping head of bed flat
Encourage independence with use of trapeze
Ensure sling is smooth and does not apply undue pressure on popliteal space
or peroneal nerve or lateral aspect of knee

d. Bryant's Traction

is used to immobilize a fracture of the femur in children who weigh less

than 40 pounds (18.2 kg. ). This skin traction is a simple running
traction in which the legs are raised at 90 degree angle to the body.
Both legs are held in traction for comport and balance even though
only one leg is affected.
Care for patients with Bryants Traction:
Raise buttocks slightly from mattress
Observe bandages carefully for slippage and bunching over heel cords
Observe for skin sloughing on both legs
Check feet for color, pulses, warmth, and sensation q2h to q4h
Use harness restraint to prevent turning over
Avoid thick, wide diapers between legs
Used in children younger than 3 years, weighing less than 30lb
Apply bilaterally with hips with hips flexed 45 degrees and legs in
extension
Ensure skin integrity with nonadhesive straps and wraps that do not
impair neurovascular status
Ensure buttocks are elevated 1 to 2in. from mattress
Ensure parents understanding of the purpose and use of traction
Utilize jacket or vest restraint to prevent child from rotating in the bed
e. Cervical Head Halter Traction

for neck pain, neck strain and whiplash, traction can be applied to the
cervical spine by means of a head halter. The pull of cervical skin
traction should be felt as an upward pull on the back of the neck. A
slight change in the level of the head of the bed is often the key to
correct application of this type of traction. Because this is a form of
skin traction, it cannot be used for prolonged periods.
this type of traction is often used by client at home with the client
sitting in a chair.It can be used to alleviate painful muscle spasm of the
neck, to create alignment, or to prevent deformities.

Care for patients with Cervical traction:

Apply manual traction if pin loosens or penetration occurs. Notify physician
immediately.
May use turning frames or special beds for positioning
Provide pin care according to physicians order and institutional policy
Position without pillows
Take care that weight and pulley are free of wall
Observe for pressure areas
Jaws and ears
Side of head
Back of head
Pad as necessary for comfort

2.SKELETAL TRACTION
-is a applied directly to the bone with wires or pins that are inserted
during surgery.

TYPES OF SKELETAL TRACTION

Skull Traction or Head Traction

this form of skeletal traction is accomplished by inserting a points of a

skull tong device (such as Vinke or Crutchfield tongs) into the skull
bone. It is used reduced a fracture of the cervical vertebrae. This type
traction is often used only temporarily until a halo device can be
placed.

Care of patients with Skeletal Traction:

Cover ends of pin with cork
Observe site of insetion
Redness
Swelling
Discharge
Odor
Bleeding
Clean skin around puncture sites as ordered

3. RUNNING TRACTION
- is a pulled in one direction against the long axis of the body or
bone. With this type of traction, the body must be aligned with
the pulling force to be effective

4. Continuous or Intermittent Traction

TYPES OF FIXATOR
EXTERNAL FIXATOR

-is the device is used to manage complex fractures that associated with soft
tissue damage or with open wounds in the fractures area. A physician inserts
multiple pins that protrude through the clients of skin into the bone
fragments. The external fixation device is a metal frame that, on the outside
of the body, holds the pins in place and maintains immobilization. The
picture shown is an example of external fixator being used in the treatment
of a fractured radius bone.

INTERNAL FIXATOR

Internal fixation is done through open reduction, the surgeon places a pin,
wire, screw, plate, nail or rod into or onto the bone to keep it reduced
(properly aligned), immobilized, or both. This procedure is called open
reduction, internal fixation (ORIF) and is the treatment of choice for certain
fractures in which casting is generally impossible (hip fracture).
Internal fixation can be performed using various devices. It is most frequently
with fractures of the legs long bones, in which case the spike is called
intermedullary nail

SCIENTIFIC PRINCIPLES INVOLVED IN TRACTION

1. Anatomy and physiology
- traction care involves the musculoskeletal system. Nurses should be
knowledgeable of the body parts affected to prevent complications.
The knowledge about skeletal system which includes the bones, joints
and the skin involved regarding to the care of the patients with
traction. The nurse should know this to imply the different area
affected and to make nursing interventions immediately if the patient
undergone different complications towards the procedure.
2. Microbiology
- patients who have traction are of great risk for skin infection because
the skin integrity is being altered. The nurse observes the pin sites at
least every 8 hours for drainage, color and severe redness which
indicate inflammation and possible infection. To prevent infection to
happen the nurse must observe this principle.
3. Physics
- the nurse should observe on the friction between traction part and
the bed. Also the nurse should know the mechanical devices such as
ropes, pulleys, and weights supply is used properly for the part to be
traction to prevent further injury.

4. Psychology
- adequate explanation of the procedure to be used in applying and
maintaining the traction is essential. Provide privacy to the patient.
Give time to patient that he can accept the injury that he had. Provide
good environment to prevent depression of the patient.

5. Safety and Security

-the nurse should observe on the safety of the patient to prevent
aggravation on the injured part. This is also to prevent fall of the
patient that may cause further injury.

COMPLICATIONS OF TRACTION APPLICATION:

1. SKIN BREAKDOWN results from irritation caused by contact of the skin
with the tape or foam and shearing forces. Older adults are at greater risk for
this complication because of their sensitive and fragile skin.
Monitoring and Managing Skin Breakdown:
-

during the initial assessment, the nurse identifies sensitive,

fragile skin (common in older adults)
the nurse closely monitors the status of the skin in contact
with tape or foam to ensure that shearing forces are
avoided
the nurse performs the following procedures to monitor
and prevent skin breakdown:
removes the foam boots to inspect the skin,
the ankle and the Achilles tendon three times a
day
the nurse is needed to support the extremity
during the inspection of akin care
palpates the area of the traction tapes daily to
detect underlying tenderness
provide back care at least every 2 hours to
prevent pressure ulcers. The patient must
remain in a supine position to prevent the
increased risk of the development of pressure
ulcers
uses a special mattress overlays (e.g filled,
high-foam) to prevent pressure ulcers.

2. NERVE DAMAGE skin traction can place pressure on peripheral nerves.

When traction is applied to the lower extremity, care must be taken to avoid
pressure on the peroneal nerve at the point at which it passes around the
neck of fibula just below the knee. Pressure at this point can cause foot drop.
Weakness of dorsiflexion or foot movement and inversion of the foot
indicate pressure on the common peroneal nerve. Plantar flexion
demonstrates function of the tibial nerve.
The following are important points to keep in mind when caring for patient in
traction:
regularly assess sensation and motion
immediately investigate any complaint of burning sensation under the
traction bandage or boot
promptly report altered sensation or impaired motor function

3. CONSTIPATION AND ANOREXIA reduced gastrointestinal motility

results to constipation and anorexia.
Encourage a diet high in fiber and fluids may stimulate gastric motility
If constipation develops Therapeutic measures may include: stool
softeners
To improve patients appetite, the nurse identifies and includes the
patients food preferences, as appropriate, within the prescribed
therapeutic diet.

4. VENOUS THROMBOEMBOLISM venous stasis that predisposes the

patient to venous thromboembolism occurs with immobility.
The nurse teaches the patient to perform ankle and foot exercises
within the limits of the traction therapy every 1-2 hours when awake to
prevent DVT.
The patient is encouraged to drink fluids to prevent dehydration and
associated hemoconcentration, which contributes to stasis.
The nurse monitors the patient for signs of DVT including unilateral
calf tenderness, warmth, redness and swelling (increased calf
circumference)

 The nurse promptly reports finding to the physician for definitive

evaluation and therapy.

5. CIRCULATORY IMPAIREMENT is manifested by cold skin temperature,

decreased peripheral pulses, slow capillary refill time and bluish skin. After
traction is applied, the nurse assesses circulation of the foot or hand within
15 to 30 minutes and every 1 to 2 hours.
The nurse encourages the patient to perform active foot exercise every
hour when awake.

6. PRESSURE ULCERS
The nurse examines the patients skin frequently for evidence of
pressure or friction, paying special attention to bony prominences.
It is helpful to reposition the patient frequently and to use protective
devices (e.g elbow protectors) to relieve pressure.
The nurse consult
continence nurse.

with

the

physician

and

the

woundostomy-

7. URINARY STASIS AND INFECTION incomplete emptying of the bladder

related to positioning of the bed can result in urinary stasis in infection. In
addition, the patient may find use of the bedpan uncomfortable and may
limit fluids tominimize the frequency of urination.
The nurse monitors the fluid intake and character of the urine.
The nurse teaches the patient to consume adequate amounts of fluid
and to void every 3-4 hours
If the patient exhibits signs or symptoms of urinary tract infection ,the
nurse notifies the physician

7. GENERAL CARE OF PATIENTS WITH TRACTION

7.1. ASSESSMENT OF A BODY PART

7.1.1 Circulation
- check the skin color, joint motion, complaints of numbness,
coldness or swelling over the extremity. Avoid pressure in the popliteal
space.
7.1.2 Condition of the skin
- check the skin areas over Achilles tendon, dorsum of the foot,
heel, and sacral region.
7.1.3 Body alignment and position of the extremity
- is the purpose of the traction being accomplished?
7.1.4 Prevention of deformity
- have measures been provided to prevent foot drop, hip flexion
and contracture? Is the backrest lowered several times daily to provide for
complete extension of the hip joints?
7.1.5 Countertraction
- is countertraction sufficient or does the foot plate frequently
rest against the foot of the bed.

7.1.6 Slipping
- is there slipping of the traction tapes and does outer bandage
need rewrapping?
7.1.7 Pressure
- is there pressure on the lateral aspect of the leg over the head
of the fibula? Pressure in this area may result in a palsy of the peroneal
nerve.
7.1.8 Patients Comfort
- traction should never be a source of undue discomfort for the
patient. Listen carefully and heed complaints of discomfort.
7.1.9 Complication

- because of the prolonged bed rest and minimal activity,

hypostatic pneumonia is a constant threat, particularly to the elderly patient.
Encourage coughing and deep breathing.
7.2. HANDLING NEW TRACTION
- inspect traction apparatus frequently to ensure the ropes are running
straight and through the middle of the pulleys; the weights are hanging free;
that bed clothes, the bed or the frame or bars of the bed are not impinging
on any part of the traction apparatus
- check ropes frequently to be sure they are not frayed.
- Avoid releasing weights from or altering the line of pull of the traction.
- Avoid adding weight to the traction
- Check the position of the Thomas splint frequently; if the ring is away from
the groin, readjust the splint to its proper position without releasing the
traction.
- Avoid bumping into the bed or traction equipment
- Be sure that weights are securely fastened to their ropes
- Avoid manipulation of pins
7.3. SKIN CARE
- encourage the patient to turn slightly from side to side and to lift hip up on
the trapeze to relieve pressure on the skin on the sacrum and scapulae
- avoid padding the ring of the Thomas splint- since this will create dampness
next to the skin. Bathe the skin beneath the ring, dry it thoroughly, and
powder the skin lightly.
- inspect skin frequently to be sure that it is not being rubbed, macerated by
traction equipment; readjust splint or the extremity in the splint to free the
skin from pressure
- keep skin areas around the pin sites clean and dry
7.4. TURNING
- Never lift or change traction weights without a doctors order
- Do not remove traction or increase or decrease the amount of the weight
without specific orders
- Always tell the patient when youre going to remove or re-apply the tension
- Never drop a weight when reapplying traction but gradually lower the
weight so the patient does not undergo sudden extreme stress

- a patient who may have the head rest up and down should be positioned
completely flat at least half the time to prevent hip flexion contractures.
- When traction is applied to the leg a foot plate may be applied to prevent
foot drop
- If patients leg is in traction the foot should never rest
- Turning to any position is generally permitted as long as the integrity of the
traction is not compromised and the patient is comfortable.
- prevent rotation of the leg and splint. The heel should not rest on the bed or
pressure necrosis will develop
- If pillows are used they should be firmed so they will provide adequate
support and will maintain alignment of the limb of the traction apparatus.
- the elevation of the heel should not hyperextend the knee
5. TOILETING
- use a fracture pan with blanket roll or padding as support under the back
- protect the Thomas ring splint with water proof material when female
patients are using the bed pan.

In Partial Fulfillment in the

Requirements of the Subject
Related Learning Experience 105

Care of Patients with

Traction

Submitted by: Mercado, Sean Derick C.

Submitted to: Mrs. Myriam Lilia F. Nuez